How Do You Sell to Physicians?

Physicians are the lifeblood of many a healthcare organization. As competition increases for their attention whether it be a hospital, specialty pharmacy, medical device manufacturer, or pharmaceutical company, cutting through the din of messages and relationships can be a daunting task. So how do you cut through all of the chatter and have marketing and sales work together effectively?

Be the solutions provider!

You are supplying solutions to solve the physician practice challenges by providing data-driven or process solutions to those issues in practicing medicine in today's environment of change. And they must at a minimum, accomplish several things: A) practice medicine more efficiently; B) measurably improve the quality of care; C) assist in generating additional revenue; D) are cost effective; E) easy for the physician and office staff to use; and F) reduce the patient hassle factor by cutting down on complaints, or, as we like to say, increase patient satisfaction.

With that in mind, some basic rules of thumb apply:

1) Your sales people must be using a common sales strategy across the enterprise. I have seen too many organizations (hospitals mostly) where everybody's left to their own methods resulting in incorrect messaging and using poorly designed home-grown materials which could have some significant legal repercussions for the organization. Your sales force activities are about relationship selling and acting as the liaison for the physician to your organization. If you don't have a method and training, chances are you will not be as effective as your competition.

2) Use a sales database system to collect information and the marketing department needs to have full access. If your just starting to look at one, marketing needs to be at that table. Don't assume that sales or IT knows what marketing needs. They don't. Systems breed accountability on all sides of the ledger.

3) Create an interdisciplinary marketing and sales advisory committee. Where most organizations fall down is the poor communication and working relationships between sales and marketing. You have to get past the "the feet on the street" don't deliver the brand messages and promise in the right way, and all that marketing is good for is creating stuff, because I need more stuff to leave behind attitudes.

4) Train your marketing department in the sale approach that your sales people are using. This way marketing begins to understand the opportunities and challenges faced, and how your sales staff is trained to overcome them. This means that all marketing materials should be created to be applicable and useful at some point in the sales cycle. It's all about shortening the sales cycle. Effective materials will assist in that goal.

5) Let your marketing people go out on sales calls and major presentations. They can be a new set of eyes and ears as well as providing them with new perspectives on how difficult the job is. Insights from other areas will make you a stronger organization.

6) Cut down on the number of slide you use for presentations. An 80 page slide deck is all about you and nothing about your potential customer. If you have to use more than 10 slides, you don't know what you are talking about and don't understand your audience. Talking head are boring.

7) Have marketing attend you sales meetings and weekly funnel calls. It's about relationships and dialogue. Marketing should have a roll in explaining the organizational strategy, and what they are doing to generate meaningful leads for sales to follow-up on.

8) Joint marketing and sales goals and objectives should be established. Share in the pain and share in the gain.

9) Constantly evaluate and begin again.

As healthcare reform continues to be implemented and becomes more fully defined, the consolidation of healthcare providers will continue unabated. Physicians will play an exceedingly important role in the revenue opportunities for your organization. The physician is your partner. Ignore them at your own risk.

You can continue the conversation with me on:
LinkedIn: http://www.linkedin.com/in/krivich0707
Twitter: http://www.twitter.com/mkrivich

For more information, or to discuss you marketing and sales integration needs, you can learn more at my web site the michael J group; email- michael@themichaeljgroup.com ; or phone by calling me 815-293-1471.

Selling the Physician to Increase Volume and Revenue

Any number of healthcare organizations are looking to increase admissions to drive revenue and volume by associated physicians. Some providers are returning to the days of employing physicians and that seems to be making a big comeback due to the Patient Protection and Affordable Care Act (PPAAC). Here's hoping lessons learned from the last go around of physician employment will result in fewer mistakes this time.

Sales staffs are popping up all over like weeds-in-a-field, complete with goals and objectives, territories and sales quotas for specific docs along identified and profitable disease-states. In most cases they are managed by people who have never sold anything in their life. Little understanding of the relationship sales cycle, what is important to the physicians, their needs and ultimately their patients. The first time the sale person comes back to the organization with "This needs to change" request, it all breaks down because nobody internally wants to really change anything. We just want volume and revenue. Besides, with all the Stark considerations we really can't do too much anyway.

What's wrong with this picture?

Too sell to physicians successfully, you need more than office lunches and how are the kids kind of conversations. Its about their experience in admitting, treating and referring patients to your emergency room, hospital, pharmacy, surgical center or a home care agency to name a few of the providers docs deal with on a daily basis. Everyone is out there with the send to me, me, me, message. And that can't go on any longer.

Its more than your own perceived features and benefits.

This is a relationship sell and your sales team needs to be on track with a common sales methodology that they all use. Leaving it up to the nice person in the medical staff office to do this because she makes the docs laugh, or assigning a sales managerial function to someone who has never sold a day in their life, especially in healthcare, is a receipt for disaster.

Be ready to make changes in how you do things. When your sales person comes back, and says he or she is finding a trend in obstacles physicians are encountering in admitting or practicing medicine in your organization, be ready to make meaningful changes. If not, your just wasting your time and money sending out people to increase volume and revenue from a physician or multispecialty group. Nothing worse than over-promising and under-delivering.

10 Steps for Success

1. Hire a sales manager that has healthcare sales experience. Make it a VP level position at the senior management table. They drive strategy to make sure it is in sync with the organizational business plan and financial objects, as well as act as an agent for internal change.

One of the great weaknesses in healthcare senior management is that people who are very well educated, read an article, go to a seminar and then think they know everything they need to know too implement a strategy. Healthcare leadership has got to change in this new consumer driven environment and learn they don't know everything. The sooner you make that realization the more successful you will be.

2. Hire trained healthcare physician sales individuals. Lots of people from pharma and medical device companies make great hospital and other healthcare provider sales representatives.

3. Make sure that everyone is using the same sales methodology, techniques and materials. All sales and marketing materials should be designed for use in for the specific point in the sales cycle.. One size does not fit all.

4. Use a sales database system like SalesForce.com for example for accountability, tracking, etc., and make sure your marketing department has full access to the information. Mine the data for strategy and new opportunities.

5. Integrate your marketing and sales efforts from day one. You have to avoid the internal conflicts which arise and those "Marketing is clueless about what we need" or "The feet on the street don't sell it like we want them too", kind of conversations. Integrate and create a joint sales marketing committee to solve a lot of that. Make sure your marketing team is trained in the sales methodology the sales force is using. Marketing should also be attending sales calls.

6. Establish joint goals, objectives and revenue targets for sales and marketing. Share in the pain, share in the gain.

7. Make meaningful changes to your products and services based on the needs and expectations of your customers. That does not mean one-offs, but changes across the enterprise that will benefit many.

8. Remember it's about the brand, your brand promise and how your brand delivers upon those expectations.

9. Make sure that the entire organization knows what you are doing. Nothing more embarrassing or damaging when someone at any level of the organization is clueless and can't be supportive of the sales and marketing efforts. Makes you look like you do not know what you are doing.

10, Evaluate, monitor performance, make changes as needed in the program or staff and start the cycle again.

To your success.

You can continue the conversation with me on:

LinkedIn: http://www.linkedin.com/in/krivich0707
Twitter: http://www.twitter.com/mkrivich
facebook: http://www.facebook.com/michaelkrivich

Michael Krivich is Fellow, American College of Healthcare Executives and a Professional Certified Marketer, American Marketing Association and can be reached at michael@themichaeljgroup.com or 815-293-1471 for consulting services in strategic marketing, integration of sales and marketing, media relations and interim marketing executive leadership assignments. Huthwaite SPIN selling trained and a Miller Heiman Strategic Selling alumni, both highly respected and successful international sales training organizations, I can lead your organization though the challenge of integrating sales and marketing.

Consumer Satisfaction in Healthcare Marketing

The dynamic has changed.

With the advent of HCAPHS and the Affordable Care Act (ACA) consumer satisfaction is no longer a nice too have but a got to have in healthcare. Difficult to achieve and tough to beat once you have it, consumer satisfaction with your medical services, regardless of the monikers we place on them, will drive volume and revenue. Revenue for the standpoint of Pay-for-Performance (P4P) programs and volume from consumers selecting you in a very "commoditized" and provider undifferentiated healthcare market place. As you create your networks, Accountable Care Organizations (ACOs), Medical Homes (MHs) and other yet undefined organizations, you have the opportunity to "get it right" this time.

For the past 10 years, I have been writing and working within healthcare organizations to improve satisfaction. Ten years ago, I had the opportunity to coauthor a book with Ralph Bell, PhD., on satisfaction entitled- How to Use Patient Satisfaction Data to Improve Healthcare Quality, American Quality Society, Quality Press www.asq.org/quality-press . This past weekend I received a notice that the publication run worldwide is 843 copies to date and counting. The books relevancy today is even more so than it was when first written given the changes in healthcare in the U. S.

The healthcare consumer of today will view your services as: value= f(cost, quality, satisfaction) as compared to the near past where value= f(cost, quality). Value here is the defining moment and is a function of cost, quality and satisfaction with you.

Marketing Implications

With the ACA and HCAPHS Hospital survey in play by reporting provider satisfaction as a common basis for measurement and consumer comparison, all the more imperative the focus on patient satisfaction. Healthcare is not an easy business by any stretch of the imagination. We work with people who are patients and their families that are at various states of emotional distress, caring employees (for the most part), good physicians etc. So satisfaction for so many different groups becomes interrelated.

Why is it important?

High levels of satisfaction are a powerful differentiators on your market, negotiations with insurance companies and your physicians.

Done correctly, your satisfaction program becomes the Voice of the Customer (VoC) to drive real organizational change.

It is a strategic and tactical edge for your brand and your marketing communication efforts.

Think customer evangelization.

Where does satisfaction start?

No surprise here - right in the executive suite. The CEO and senior leadership sets the tone, tenor and actions by what they do or don't do. How they treat others. How they measure and hold themselves accountable in the performance evaluation process. It's either part of the culture or not. People clearly trained, as well as understand the organizational rationale, policies, procedures for satisfaction and are part of the program, or they see it as the flavor of the day because so and so said so.

Satisfaction is a Process

Patient satisfaction is a process that is controllable and understandable. It is the voice of your customer. By listening to that voice, I mean really listening to that voice, you would be surprised at the improvements that you can make in your healthcare setting. Patients, physicians and others view the hospital experience not as a set of unrelated departments where things are done to me, but as a coordinated whole in a continuous process.

Where do we go from here?

It starts with learning. It starts with an honest assessment of here is where you are. It starts in the C-suite. Commitment, compassion, understanding, listening, process control and improvement.

The choice is yours. The marketing implications, strategies and tactics are clear. Lead or be left behind.

You can continue the conversation with me on:

LinkedIn: http://www.linkedin.com/in/krivich0707
Twitter: http://www.twitter.com/mkrivich

Michael Krivich is Fellow, American College of Healthcare Executives and a Professional Certified Marketer, American Marketing Association and can be reached at michael@themichaeljgroup.com or 815-293-1471 for consulting services in strategic marketing, integration of sales and marketing, media relations and interim marketing executive leadership assignments. Huthwaite SPIN selling trained and a Miller Heiman Strategic Selling alumni, both highly respected and successful international sales training organizations , I can lead your organization though the challenge of integrating sales and marketing.

Selling to Physicians Through Integrated Marketing and Sales

Physicians are the lifeblood of many a healthcare organization. As competition increases for their attention whether it be a hospital, specialty pharmacy, medical device manufacturer, or pharmaceutical company to name a few, cutting through the din of messages and relationships can be a daunting task.

For hospitals failure to build successful relationships and sales strategies mean that your docs could admit patients elsewhere. Note to hospitals: If you are not selling to docs, then you're missing a great opportunity to build volume by creating a more committed medical staff than if you just doing "relations or liaison" activities. You can sell legally and effectively if you know what you are doing.

For medical device manufacturers, failure to sell the doc mean a more difficult time selling your product into the venue where the physician practices medicine.

For specialty pharmacies, the physician sends his or her patients elsewhere.

So how do you cut through all of the chatter and have marketing and sales work together effectively?

No magic answers here.

No pixie dust either.

But here are 10 rules of thumb for moving forward:

1) Your sales people must be using a common sales strategy across the enterprise. I have seen too many organizations where everybody's left to their own methods resulting in incorrect messaging and using poorly designed home-grown materials which could have some significant legal repercussions for the organization. Your sales force activities are about relationship selling and acting as the liaison for the physician to your organization. If you don't have a method and training, chances are you will not be as effective as your competition.

2) Use a sales database system to collect information and the marketing department needs to have full access. If your just starting to look at one, marketing needs to be at that table. Don't assume that sales or IT knows what marketing needs. They don't. Systems breed accountability on all sides of the ledger.

3) Create an interdisciplinary marketing and sales advisory committee. Where most organizations fall down is the poor communication and working relationships between sales and marketing. You have to get past the "the feet on the street" don't deliver the brand messages and promise in the right way, and all that marketing is good for is creating stuff, because I need more stuff to leave behind attitudes.

4) Train your marketing department in the sale approach that your sales people are using. This way marketing begins to understand the opportunities and challenges faced, and how your sales staff is trained to overcome them. This means that all marketing materials should be created to be applicable and useful at some point in the sales cycle. It's all about shortening the sales cycle. Effective materials will assist in that goal.

5) Let your marketing people go out on sales calls and major presentations. They can be a new set of eyes and ears as well as providing them with new perspectives on how difficult the job is. Insights from other areas will make you a stronger organization.

6) Cut down on the number of slide you use for presentations. An 80 page slide deck is all about you and nothing about your potential customer. If you have to use more than 10 slides, you don't know what you are talking about and don't understand your audience. Talking head are boring.

7) Marketing departments need to see what sales people have created for use in their markets. Sales people are creative and resourceful. You may find some useful material to use and distribute across the entire organizations.

8) Have marketing attend you sales meetings and weekly funnel calls. It's about relationships and dialogue. Marketing should have a roll in explaining the organizational strategy, and what they are doing to generate meaningful leads for sales to follow-up on.

9) Joint marketing and sales goals and objectives should be established. Share in the pain and share in the gain.

10) Constantly evaluate and begin again.

Michael Krivich is Fellow, American College of Healthcare Executives and a Professional Certified Marketer, American Marketing Association and can be reached at michael@themichaeljgroup.com or 815-293-1471 for consulting services in strategic marketing, media relations and interim marketing executive leadership assignments. Huthwaite SPIN selling trained and a Miller Heiman Strategic Selling alumni, both highly respected and successful international sales training organizations , I can lead your organization though the challenge of integrating sales and marketing.

Marketing Healthcare PACS & RIS IT Solutions

This post is a little different for me. Usually, I am looking at the hospital side of the marketing equation and not so much the sales vendor side. Having worked on both the hospital and IT vendor side Radiology Information System, (RIS), Picture Archiving Communication System (PACS) and Electronic Medical Record (EMR), it is most interesting to compare. The great challenge is selling into two spaces simultaneously, the physician and the C-Suite. Messages may be the similar and different at the same time. Once size does not fit all. Additionally, this is not an all inclusive look at marketing PACS and RIS.

I am not addressing the sales side of the equation. That's a discussion for another topic at a later date. I am not anti-sales by any means being Huthwaite SPIN selling trained and a Miller Heiman Strategic Selling alumni. The integration of marketing and sales is for another day.

Just an observation but everyone is starting to look the same. It's easy to lose that differentiation that every company craves when selling similar products and services .

Key Messages

Reducing cost, improving quality, reducing medical errors, innovative, next generation, improving productivity and efficiency, easy to use, interoperability with all systems, IHE, user groups that deliver real information, increasing satisfaction for the physician, C-suite and patients are key messages everyone is using. What is wrong with this picture? The pun is intended!

So let's take a short look at some common marketing techniques and what could be done to break the log jam? Less is more....

Case Studies

Case studies are important and I would think everyone agrees on that point. Our audiences suffer from information overload. Where the observation is that those documents are way too long. Sometimes it seem like we get paid by the word, or we are so enthralled by our own system prowess that we must write in excruciating detail. If I have learned anything about case studies and white papers for physicians and the C-Suite it's two pages tops. And even that needs white space. Organize as follows; Background , Solution, Outcomes. And yes they can be written in two pages or less. Just because they are shorter doesn't mean you're treating your audience like an idiot. They most likely will appreciate the brevity.

Also, if you keep them shorter you can use them as the basis for email campaigns. But that too requires creativity. Use a video spokesperson to introduce the white paper or case study to drive the audience to your web site. Its electronic and can be done for $15,000 or less, including email list procurement.

White Papers

White papers it is believed, add a measure of thought leadership to your space. They do, provided you are putting them out on a regular basis and (this is the important part) are more than you writing about what you know about. White Papers need to be used as mechanism for thought-leadership, not simply writing what you know about. To be a thought leader in your field you need to write like a "thought- leader". That means taking on topics you may not feel so comfortable about. It may mean becoming a visionary and projecting out where an industry may be going. To be seen as a thought-leader you must generate though-leading content and that is content beyond what you know.

For example, those vendors who operate in the international space, think of the lessons you have learned in single payer government sponsored healthcare systems, or in Europe where there is a mix of payers where everyone has health coverage. How do those lessons translate into the transformation of the American healthcare system? That is thought leadership.

Association Meetings

Here is not so much exhibiting which some do allow, but being a co-presenter with a hospital or doc on how working together the hospital lowered cost, improved quality, increased efficiency etc. You are not the focal point but the doctor or hospital is the focal point, You play the supporting character with your product. Yes, you do have a role as a presenter but this is the soft sell and credibility established as a the content expert as well as showing you understand the pain and can make it go away. Consider being a major sponsor as well to access key decision makers one-on-one.

Webinars

Yep another me too category. However it seems that most people are still in the 9-5 mentality. Most physicians and professionals I know are usually working in their office or the hospital. So why not have these webinars in the evening or early morning before they start reviewing x-rays, digital or film? If they are not reading x-rays then they are not making money. Don't infringe on that valuable time. Be more responsive. For the C-suite, lunch time is usually good for them scheduled later in the week rather than early in the week or the middle.

Internet usage

Interactive, interactive, interactive. Way too much copy heavy web pages. Readers neither have the patience nor the desire to have to read the fine print to see what they want. Make sure your site is user friendly; no more than 3 clicks to find information. Use video messaging. Don't forget about facebook, twitter, LinkedIn, Plaxo, blogs, YouTube etc. Your audience is out there. Messages delivered across multiple channels are more effective then a one size fits all approach.

Customer Evangelists

Got to have them. If your hospitals, doctors and others won't stand up for you, then you have a problem. You're just another vendor who can be replaced. Testimonials, patient success stories, outcomes, data transparency, anything that can show others are passionate about your product. Third party conferred credibility is a powerful medium and message. Don't lose sight of it. Find them and leverage. Shame on you if you don't.

Media Relations

More than just press releases, this is the down and dirty of getting coverage. Major stories in targeted publications will do more for you than any advertisement, banner ad, webinar etc. people do believe what they read. You need a steady stream of news and information. Be proactive, build press relationships. Use the Business Wire. Target your messages for the specific press you are trying to attract. Build your news around current events in healthcare. Don't be afraid to issue a statement on your position on a topic of importance. Be seem as a content expert so that when news develops around the industry you're in, you become the go-to organization for the quote. it confers strong expert credibility for you and your companies solution products. Copies of articles can be used a leave behinds and in campaigns. Can't buy that kind of coverage and credibility. Build more than a press page- build a bio of the senior team and a speakers bureau for conference, seminars etc. If you are not out in the market presenting, then you are not being seen. Presence builds preference.

I have gone on long enough and probably too long for that matter. But from what I have seen in the segment of the healthcare industry, everybody is starting to look the same. And that could lead to a commoditization of the PACS & RIS environment where people buy only on price and nothing else.

So seller beware.....

Michael Krivich is Fellow, American College of Healthcare Executives and a Professional Certified Marketer, American Marketing Association and can be reached at michael@themichaeljgroup.com or 815-293-1471 for consulting services in strategic marketing, media relations and interim marketing executive leadership assignments.

Back to basics and de-marketing services

With major cuts in funding coming for hospitals, the only way to survive is to get back to the core. Meaning, what are those core services and programs that regardless of what happens in the world of healthcare, will pay the bills and create market strength and position for you.

Its hard to exit programs and services. I have been saying for years that hospitals can not be all things to all people anymore. That means hard choices. It also means a de-marketing program for all those classes of trade that you exit from.

It will require organizational strategic planning, a willingness to tackle the scared cows, close collaboration with your physicians, intense internal communications and a solid de-marketing and communication plan to sell it to the community.

You will be required to collaborate with your competition. Hard to admit you can't do all things well. If you want to survive, you have too.

Find the expertise to assist you along. De-marketing is an area where hospitals have little experience.

It's about the Physician

Who has patients.....doctors or hospitals?

Somewhere along the way to the informed healthcare consumer and all that hospital advertising about how good they are, the newest piece of technology and the latest greatest renovation as well as how much we care about you as a person (or your spirit, whatever that means), we have may have forgotten about the role of the doctor.... and that is not a good thing.....

Hospitals and health systems talk about "their patients". Healthcare organizations troll for consumers and employers through a variety of marketing techniques. Some have even entered into agreements with insurance companies under capitation arrangements for "covered lives" where they are paid a certain dollar amount per month per life to provide complete care. (After learning that it's not as easy as it sounds and losing millions of dollars, most hospitals and health systems have exited the insurance business. Good move.)

Physician referral programs, RN staffed call centers, community health and wellness programs, service lines in cardiology, neurology, orthopaedics and others, quarterly magazines and newsletter mailings, advertisements and public relations aimed at creating that awareness, usually center around the hospital, clinic or health system. Sometimes, just sometimes, it does center around the primary care doctor, specialist or physician group. Those hospitals and systems that do center their efforts around the doc get it.

Its about the physician......

A contrary view no doubt. But think about this for a minute. When to go to the clinic or hospital and you need a test what do you need? A doctors order. You can't walk into the Emergency Room at any healthcare facility and just go... "My shoulder hurts, give me an MRI". You need a doctors order. Want an aspirin to treat a headache in a healthcare setting, you need a doctors order. Want an antibiotic for an infection filled at your local pharmacy (unless you live in Mexico), you need a doctors order. If the hospital wants to bill for inpatient or outpatient services, managed care aside, they need the doc to put the patient in the bed or send them to the outpatient clinic. No order, no physician involvement, no bill. No bill, no revenue. It all starts and ends with the physician.

But to hear healthcare providers tell it, I belong to them. I don't belong to anyone, but have a relationship with my physician whom I trust and will go where she directs me. It does still happen to be that way for most people. Informed consumers exist and lots of available data is there for all of us to see, but the exception to the rule is the consumer who at the end of the day, will disagree about where their personal physician will send them for care.

What can hospitals learn from this....

Its about a partnership. That partnership is a three way- you, me and my doc. Stop spending so much time figuring out joint ventures, employment options and all the rest. Yes, I do admit some of it needs to be done, any organization worth its salt will look at service enhancements. That is the natural evolution of a business. But focus on the doc. Each year dozens of seminars, books and articles appear about improving medical staff relations, partnering with physicians, strategies for working together and on and on and on. Maybe its about time we learned from that and began to practice it more.

It means putting egos aside and listening. Doesn't mean you are going to do everything the physician wants, but if you listen very closely you might find some simple ways to help the physician practice medicine more efficiently, improve their satisfaction and at the end of the day increase admissions and procedures.

Want a sure fire way to improve admissions, focus some of your improvement efforts on making it easier for the physician to practice medicine in your institution. When the nurse pages the attending physician, make sure they are there when the doctor calls back. If a physicians wants a faxed copy of their ER report, send it. If the doctors office calls Admissions, have caller ID available so the admission representative can ID the doc and respond appropriately. And improve your patient satisfaction. Patients complain to their doctor about your service and care. Docs don't want to hear it. Physicians will send their patient to those facilities where it is easier to practice medicine, where they have their needs meet and their patients are satisfied.

Don't believe me. Take a look at market share data of any provider over time. Seeing only a one or two point market share swing among competing facilities? Guess what, it is not through any great marketing, its about the docs moving patients around to different facilities.

The healthcare organization that can improve physician satisfaction and make it easier for them to practice medicine in the halls of the hospital will gain admissions and outpatient business, which in turn will generate revenue, which, well you get the idea.

I admit it is not so simple with competing medical staff, the movement of services and procedures to different settings and other providers raiding medical staffs. But at the end of the day, if you can understand that it is about the doc, you will be better, the physician will be happier and patients will hold you in a new light.

Not that much different from billing the 1960s is it?

The Patient Satisfaction Imperative

As the old song goes, I can't get no....satisfaction.......

Ever wonder why in the healthcare industry that satisfaction is sometimes so hard to come by?

That is not to say that every hospital or health system has a satisfaction or service problem. There are many exemplary examples of service focused healthcare organizations that day-in and day-out deliver high levels of patient and physician satisfaction. Yet, in an industry where we "serve" individuals, we hear from consumer research that it's the other guy. My doctor and my hospital is fine as consumers report general happiness with their healthcare providers. Hospitals regularly report satisfaction in the 90th percentile. Get people outside of the hospital and you hear some pretty common complaints: the food is cold; I did not know about my test; you woke me up in the middle of the night; it was noisy; the room to cold; the room is hot; and on and on. As organizations tout the JD Powers Satisfaction Award, show great improvements in Press Ganey or NRC-Picker or other survey instruments, there is still the uneasy feeling that all was not okay. These and other survey tools are all very valid, all worthwhile, show trends and document accomplishments. With the government HCAPHS Hospital survey in play by reporting provider satisfaction as a common basis for measurement and consumer comparison, all the more imperative the focus on patient satisfaction.

Healthcare is not an easy business by any stretch of the imagination. We work with people who are patients and their families that are at various states of emotional distress, caring employees (for the most part), good physicians etc. So satisfaction for so many different groups becomes interrelated.

Why is it important?

For several valid and researched reasons.

Satisfied patients are more compliant with treatment regimens.

A satisfied patient even if the medical outcome is not good, believes that he or she had a quality medical experience.

Satisfied patients recommend you to others.

Satisfied patients return to you for care.

Satisfied patients tend to ligate less.

It's the right thing to do.

Where does satisfaction start?

No surprise here - right in the executive suite. Yep, the CEO and senior leadership sets the tone, tenor and actions by what they do or don't do. How they treat others. How they measure and hold themselves accountable in the performance evaluation process. It's either part of the culture or not. People clearly understand the organizational rationale, polices and procedures for satisfaction and are part of the program, or they see it as the flavor of the day because so and so said so.

Satisfaction is not a program or a slogan, or simply a set of behaviors codified in polices or procedures, a bar chart on the wall. It is not the notice in the hallway or patient room that if you can't rate us as very good or excellent, call this person to immediately address your needs. Satisfaction is all that and more. The defining culture of the organization. A recognition that satisfaction is every ones responsibility. It is anticipating the needs of the person or family. Taking care of the little details day-in and day-out is what creates a satisfied patient. The successful healthcare organization recognizes and understands that patient, employee and physician satisfaction are interrelated, is a process and is controllable!

The Changing Dynamic

Did you know that here appears to be a major shift in how patients and their families judge the quality of medical care? Used to be it was all based on the the hotel services, food service, housekeeping etc. Arrogantly, clinicians and hospital leaders confidently stated that patients did not have the ability to judge the technical quality of what we do.... its magic to them!

With the information available from the Internet, health and wellness programs, news stories etc, patients are very well informed and are making technical judgements of the quality of the care that they receive. Most of the time research is indicating patients technical judgement of care is on par with those of the attending physician. Now that is a dramatic change and one which is little recognized. However, it goes one step further. The dirty floor, the torn wallpaper, the piece of paper on the floor are now adding into the mix. The patient is now judging, "If they can't take care of the little things, then how can I expect them to take care of the big things...... like my treatment......... "

OK now what?

With the advent of HCHAPS, pay-for-performance, awards as well as the bragging and marketing rights in the community, patient satisfaction moves to the forefront of operational excellence. Here's the rub.... now comes the program to increase satisfaction and how to show statistically why we are better...

Here comes the program, the flavor of the day, the decree from on high....

Lies.... damn lies....and statistics........

Patient Satisfaction is a process

Patient satisfaction is a process that is controllable and understandable. It is the voice of your customer. By listening to that voice, I mean really listening to that voice, you would be surprised at the improvements that you can make in your healthcare setting. Patients, physicians and others view the hospital experience not as a set of unrelated departments where things are done to me, but as a coordinated whole in a continuous process.

Is the process of satisfaction in or out or control?

Ask any hospital executive that question and for the most part, I think they would say yes it is. Ask them to show you the data that it is in control, nine times out of ten, the subject gets changed. The simple fact is they don't know. Healthcare leadership needs to know if their process of satisfaction is in or out of control to know if they even have a satisfaction issue. A simple percentage explanation won't do that. A bar chart won't do that. A new program that is the flavor of the day for increasing satisfaction won't do that. It takes a commitment to in-depth analysis, using all the tools of Quality Management. It takes a willingness to change the culture of the organization. That is not easy. Its hard and forces some very difficult personnel decisions.

For example, say hypothetical Hospital A is dismayed about its satisfaction scores and the CEO declares, we need a 10 percent improvement in the scores. Admirable, but misguided.

If I am housekeeping and my percentage score of patient satisfaction is 70 percent, a seven point increase over time is probably doable. If I am nursing and my percentage score is 90 percent, a nine point score improvement is impossible. Flat out can't do it, not going to happen, Nada, no way. That is what happens when you only use percentage scores or a bar chart as the basis for action.

Now, had the organization been analysing the satisfaction data with the tools of Quality Management, this could have been the action on the part of leadership in a conversation in hypothetical Hospital A.

" We really need to move the culture of the organization and improve our satisfaction scores. I asked our Quality Department to do an in-depth analysis. When you look at the bar charts we see steady improvement, but regression analysis shows really not much change over time. The telling difference was when we looked at patient satisfaction scores though the use of Statistical Process Control Charts and what a story that told.

It looks like our process of satisfaction is out of control, there seems is no rhyme or reason why the scores fluctuate so much. Yes, they are all in a narrow range, but this tells me we really don't understand the process of satisfaction and how to control it. When applying this analysis to individual departments and units, we find some striking differences. Some units and departments are outperforming the organization as a whole, others could really use some improvement. I really think we need to get to those units and departments outperforming the whole and benchmark what they are doing.

So instead of everyone trying to improve 10 percent overall lets use the upper control limit of the charts as the incremental target for improvement based on historical performance. That means housekeeping you can improve 10 percent, but nursing, its really only one percent at this time. Lets make this measurement an ongoing process so that we know the point of when we designed an intervention, implemented and see the result.

What gets measure gets done, so in your goals and objectives put in place a measurement for patient satisfaction for your departments that the scores will not vary by more than 2 points plus or minus of the top score.

This isn't going to be easy. We need to really change the organization. I know we have done this before and seen some improvement. But we always fall back after a couple of months. If we go at this the right way, the employees won't see it as the flavor of the day. And we all know what that means. It may mean over time that we will lose some people. That is never good nor is it easy. But consumers, the government, payers and employers are all demanding higher performance from us. This does have a financial impact to us. As we move forward, we need to set behaviors and hold people accountable, that includes us. We need to become world class in delivering high levels of patient satisfaction."

That unfortunately is a conversation that does not take place nearly enough.

Where do we go from here

It starts with learning. It starts with an honest assessment of here is where you are. It starts in the C-suite. Commitment, compassion, understanding, listening, process control and improvement. Every hospital and healthcare provider out in the wider world has the talent, experience and expertise to do this. But what is lacking is the will. What is lacking is the understanding of the importance of patient satisfaction. Its not sexy and really hard work. For those that are willing to start, learn and change - the benefits are enormous!

If we as an industry really understood satisfaction as we claim too, do you really think that year after year dozens of books would still be published on how to improve patient satisfaction in healthcare organizations?

My Book

Okay, here is the plug for the book..."How to Use Patient Satisfaction Data to Improve Healthcare Quality", Raph Bell, Ph.D., and Michael J. Krivich, FACHE, Quality Press, January 2000, 156 pages and available on Amazon.com or from Quality Press at the American Society for Quality. Its all detailed in an easy, readable book that will assist you in reaching your satisfaction goals. Patient satisfaction is a process, it is controllable and takes work and at the end of the day, you will be better for it, your patients will be happier for it and you can outperform your competition with it.

Unless the hospital industry begins to take a more detailed data analysis and organizational approach to patient satisfaction and make it a part of the culture of the organization, we are left with lies.... damn lies.... and statistics.....

And in the end, we may be very proud of ourselves, but our patients will still have that nagging doubt about what just happened.